NYAPRS Note: Here’s a comprehensive review of the week’s news on federal Medicaid related proposals and impact by one of the nation’s most prestigious healthcare analyst groups. Manatt’s Jim Lytle will be a featured speaker at NYAPRS Annual Executive Seminar, joining a panel that will look at the anticipated impact of federal Medicaid changes on NYS that includes Families USA’s Ron Pollack, Sachs Policy Group’s Bruce Feig and the National Council’s Chuck Ingoglia. The program will open with comments from NYS Deputy Secretary for Health and Human Services Paul Francis. The Seminar, entitled “All Hands on Deck: Ensuring a Recovery Focus in a Changing Healthcare Environment,” will be held April 27-8 at the Albany Hilton.
Register today at https://rms.nyaprs.org/event/?page=CiviCRM&q=civicrm/event/info&reset=1&id=23 and hotel information at http://www.nyaprs.org/documents/2017HotelReservations.pdf.

The Senate confirmed President Trump's nominee for CMS Administrator, Seema Verma, by a 55 to 43 vote. Verma was most recently a healthcare consultant who helped develop alternative Medicaid expansion waivers in Indiana and Kentucky.

House Repeal Bill Clears Committee Markup, Moves to Budget Committee

The American Health Care Act (AHCA) advanced through the House Ways and Means and Energy and Commerce Committees on Thursday following 16 hours and 27 hours of debate, respectively. Energy and Commerce adopted one minor technical amendment; all other amendments were defeated in both committees. The bill now advances to the House Committee on the Budget for a vote in the coming days. House leadership has signaled it expects to hold a floor vote by the end of March.

CBO Scores the American Health Care Act

The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) project that the American Health Care Act would increase the number of uninsured relative to the ACA by 14 million in 2018 and by 24 million by 2026, while reducing the federal deficit by approximately $337 billion on net between 2017 and 2026. The savings would primarily come from $880 billion in reduced federal Medicaid spending (a 25% reduction) and net savings of $312 billion on federal Marketplace subsidies. CBO also estimates that individual market premiums would be 15% to 20% higher relative to the ACA until 2020, then 10% lower, on average, than premiums under the ACA between 2020 and 2026. However, premiums would be higher for older enrollees and those in high cost areas. CBO notes that coverage under the House bill would have higher deductibles and cost-sharing and lower actuarial values relative to the ACA.

National Stakeholders and Governors React to House Repeal Bill

Lawmakers, governors and other national stakeholders are weighing in on the House repeal and replace bill, with many expressing concerns, and others noting support. Those expressing concern include the American Medical Association and AARP, several hospital groups, mostDemocraticgovernors and members of Congress, and some Republican members of Congress. President Trump and HHS Secretary Tom Price have been generally supportive of the bill's framework, while statements from independent and Republican governors were mixed:

Alaska. Governor Bill Walker (I) believes the bill will shift Medicaid costs to the State, which he said the State "is not in a position" to absorb.

Arkansas. Governor Asa Hutchinson (R) said in a CNN interview on Tuesday that he does not support the bill "as it stands," adding that "it cannot be the end product" if the bill passes out of the House, as reported by Politico.

Maine. Governor Paul LePage (R) criticized the bill for preserving some of the ACA's provisions, including maintaining Medicaid expansion until 2020.

Maryland. Governor Larry Hogan (R) argued that the bill must be changed to preserve access to health insurance.

Michigan. Governor Rick Snyder (R) is concerned that the plan will drive up Medicaid costs and said that the bill does not reflect governors' input.

Mississippi. Governor Phil Bryant (R) stated that he was disappointed with the bill's similarities with the ACA and that he will be working with the State's congressional delegation "to end Obamacare once and for all."

Nevada. Governor Brian Sandoval (R) said repeal and replacement of the ACA "should be a governor-led effort" but instead the Republican repeal proposal "doesn't include anything that the governors have talked about."

Ohio. Governor John Kasich (R) restated his opposition to the ACA, but reiterated that "phasing out Medicaid coverage without a viable alternative is counterproductive," and puts Medicaid enrollees at risk.

Vermont. Governor Phil Scott (R) voiced concerns with the bill stating that it "appears [the bill] would have a detrimental effect on Vermont…We take this seriously."

Studies Examine Impact of the American Health Care ActNew studies released this week highlight the potential impact of the American Health Care Act (AHCA), including effects on coverage levels, affordability, and state costs.

A Kaiser Family Foundation issue brief and interactive county-level map estimate that average tax credits under the AHCA would be 36% lower than the ACA in 2020, 41% lower in 2022, and 44% lower in 2027. The Foundation also released a comparison tool that enables side-by-side comparisons of the ACA and Republican repeal and replace proposals, including the AHCA, across a number of factors, such as premium and cost-sharing subsidies, benefit design, individual health market rules, and financing.

A Commonwealth Fund fact sheet on high-risk pools, a feature of the AHCA, estimates that covering the approximately 15.4 million Americans with pre-existing conditions in 2014 through high-risk pools would cost the federal government an additional $178 billion per year. Funding for high-risk pools would fall short under House proposals, the authors argue.

The Center on Budget and Policy Priorities estimates that tax credits for consumers in 11 high-cost states would be approximately 50% lower under than AHCA compared to the ACA, given that tax credits under the AHCA do not account for geographic variation in the cost of insurance premiums.

…New York: One Million Could Lose Coverage Under Proposed Healthcare Bill

A Department of Health (DOH) analysis found that the American Health Care Act (AHCA) will cause one million New Yorkers to "face significant loss of coverage," in part due to the elimination of the State's Basic Health Plan. DOH projected that the AHCA would shift $4.5 billion in total spending to New York State, counties, and safety net hospitals over the next four years. Additionally, DOH estimated that New Yorkers participating in New York's State-based Marketplace would lose $400 million in premium subsidies.